Healthcare Provider Details

I. General information

NPI: 1891740510
Provider Name (Legal Business Name): BRANDI DAWN HARDIN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2006
Last Update Date: 01/14/2021
Certification Date: 01/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

475 HEYWOOD AVE
SPARTANBURG SC
29307-1726
US

IV. Provider business mailing address

PO BOX 743070
ATLANTA GA
30374-3070
US

V. Phone/Fax

Practice location:
  • Phone: 864-699-5020
  • Fax: 864-699-5050
Mailing address:
  • Phone: 864-560-4304
  • Fax: 864-560-4413

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VX0000X
TaxonomyObstetrics Physician
License Number22166
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: